HomeMy WebLinkAboutBLD2015-01048 SFR, Garage, Deck - BLD Permit / Conditions - 2/5/2016 Inspection Line (360)427-7262
P aN Cot, MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext. 352
Mason County Bldg. 8
615 West Alder Street
Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT
BLD2015-01048
OWNER: RICK& KRISTEN SHERIDAN RECEIVED: 12/16/2015
CONTRACTOR: VAN DIJK HOMES LLC 360-801-4912 LICENSE: VANDIDH869Q1 EXP: 11/21/2016 ISSUED: 2/5/2016
SITE ADDRESS: 90 E HOFAKER RD ALLYN EXPIRES: 8/5/2016
PARCEL NUMBER: 122175300042
LEGAL DESCRIPTION: LAKELAND VILLAGE#12 - PHASE I LOT: 42
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
NEW SFR, 2840 SQ FT WITH 988 SW FT GARAGE AND 421 SQ FT WA ST RT 3N, LEFT HOMESTEAD DR, RT E OLD RANCH RD, RT E
COVERED DECK SODERBERG RD, LEFT ONTO E HOFAKER RD, SITE ON RIGHT
General Information Construction&Occupancy Information Square Footage Information
No. of Bedrooms: 4 Type of Constr.: New SFR
Type of Use: SF Insp.Area: No. of Bathrooms: 3 Occ. Group: R Lot Size: Deck: 421
Type of Work: NEW Fire Dist.: 5 No. of Stories: 2 Occ. Load: Building:2,840 Garage-Attached 988
Valuation: $ 372,600.42 Building Height: 28 Occ. Status: Basement:
Manufactured Home Information Setback Information Shoreline&Planning Information
dy:Water Bo :
Make: Length: Ft. Front: E 20.0 Ft. Shoreline: Ft. SEPAy
Rear: W 20.0 Ft. Slope: Ft. Unkn
Model: Width: Ft. Side 1: N 5.0 Ft. Shoreline Desig.: bWtiApplicable
Year: Serial No.: I Side 2: S 9.0 Ft. Comp. Plan Desig.: Urban Growth Area
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Bath Tubs 3 Dryer Vent 1 EH Plan Review JBN 12/16/201 $205.00 S2201500000001
Clothes Washer 1 Exhaust Hood 1 Planning Review Fee JBN 12/16/201 $205.00 S2201500000001
Dishwasher 1 Fireplace 1 Plan Check Fee JBN 12/16/201 $ 1,639.66 S220150000000i
Hosebibs 4 Furnace>100K 1 Building State Fee CRE 1/8/2016 $4.50 S1201600000001
Kitchen Sink 1 Heat Pump 1 Building Permit Fee CRE 1/8/2016 $2,522.55 S1201600000001
Lavatories 4 Ventilation Fan 5 Mechanical Permit Fee CRE 1/8/2016 $ 191.90 S1201600000001
Water Closets (Toilets) 3 Mechanical Base Fee CRE 1/8/2016 $28.50 S1201600000001
Water Heaters 1 Plumbing Permit Fee CRE 1/8/2016 $ 136.70 S1201600000001
Showers 1 Plumbing Base Fee CRE 1/8/2016 $24.70 S1201600000001
Total $4,958.51
BLD2015-01048 Please refer to the following pages for conditions of this permit. Page 1 of 6
CASE NOTES FOR
BLD2015-01048
CONDITIONS FOR
BLD2015-01048
1) Appr a er ensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
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2) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division.
There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
1-800-647- 98 he person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
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3) All approved plans are required to be on-site for inspection purposes. If an inspection is called for and plans are not available on site, then approval will
not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building
Department riot ny further inspections being performed or approvals granted.
4) Applicati n cno �tlges that the structure is only permitted for a use consistent with the current zoning of the parcel. Zoning is Allyn UGA R1 P zone.
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5) All construction and demolition debris must be removed from the site after project completion. Proper disp I of construction debris must be on land in
such a manner that debris cannot enter or cause water quality degradation of State waters. X
6) Temporary erosion control measures must be implemented to prevent water quality degradation of adjacent waters 9Lproperties. Silt fencing, straw, or
surface matting must be installed and maintained until upland vegetation has become established. X
7) Con cr to ac and wash water must be contained during construction pouring, such that water quality degradation of adjacent waters does not occur.
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8) Own r � '�' responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
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9) ALL FURNACE INSTALLATIONS SHALL MEET THE MINIMUM EFFICIENCIES SET FORTH IN THE CURENT EDITION OF THE WASHINGTON
STATE ENERGY CODE (WSEC). ANY PORTION OF THE MECHANICAL SYSTEM THAT IS ALTERED OR REPLACED SHALL MEET THE MINIMUM
STANDARDS S ORTH IN THE WSEC AND INTERNATIONAL MECHANICAL CODE.
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10) THE FOUNDATIO STEM SHALL BE PLACED ON UNDISTURBED, FIRM-NATIVE SOIL.
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BLD2015-01048 Please refer to the following pages for conditions of this permit. Page 2 of 6
11) The"approved" site plan is required to be on-site for inspection purposes. If an inspection is requested and the"approved" site plan is not on site, then
approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and shall be collected by the
Build' Dep ent prior to any further inspections being performed or approvals granted.
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12) 2012 IECC/Washington State Energy Code Compliance has been approved as follows:
Heat Type: Electric or other than electric, Compliance Method: Prescriptive option Marine-4C, Window(Max U-Factor):0.30, Skylight(Max
U-Factor):0.50, Doors (Type/Max U-Factor):0.30 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation min. R-49, Vault Insulation R-38,
and Slab Insulation R-10.
In addition the following credits from R406.2 shall be completed as follows:
3b Air source heat pump with a minimum HSPF of 8.5
5a Electric wate_rheater with a minimum EF of.93
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13) A permanent certificate, completed by the owner, builder or registered design professional, shall be posted within three feet of the electrical distribution
panel. The certificate shall list the predominant R-values of insulation installed in or on ceiling/roof, walls, foundation (slab, basement wall, crawlspace wall
and/or floor), and ducts outside the conditioned spaces; U-factors for fenestration; and the solar heat gain coefficient(SHGC) of fenestration. Where there
is more than one value for each component, the certificate shall list the value covering the largest area. The certificate shall list the type and efficiency of
heating, cooling, and service water heating equipment, duct leakage rates including test conditions as specified in WSEC Section 105.4, and air leakage
results if a blower door test was conducted.
Building envelope air leakage control shall be considered acceptable when tested to have an air leakage less than 5 air changes per hour when tested
with a blower door in accordanve with IECC/.WSEC Section R402.4.
The blower door test results shall be recorded on the permanent certificate required located near the electrical distribution panel. Air leakage testing is
not required for additions less than 750 square feet. Reference IECC/WSEC R401.3 & R101.4.3
Compliance certificates are available online at the WSU Energy program website titled, "WSEC 2012 Certificate" and are available in %<or%2 sheets. The
Mason County Permit Center will also have some available.
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14) A minimum of 75 percent of all permanently installed lamps in lighting fixtures shall be high efficacy lamps in accordance with IECC/WSEC Section
R404.1.
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15) A concrete encased grounding electrode must be installed and used at each new building or structure that is built upon a permanent concrete foundation.
In Mason County the electrical code is regulated by Washington State Department of Labor& Industries (L&I).
For more information contact L&I for additional information. In Olympia call (360)902-6350 and in Bremerton call (360)415-4000.
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BLD2015-01048 Please refer to the following pages for conditions of this permit. Page 3 of 6
16) Concrete used for basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other
vertical concrete work exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2).
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17) Carbon monoxide alarms, listed as complying with UL 2075 shall be installed in accordance with manufacturer specifications and in accordance with IRC
Section R315.
Alarms shall be installed outside of each separate sleeping area in the immediate vicinity of the bedrooms and on each level of the dwelling.
EXISTING DWELLINGS shall be equipped with carbon monoxide alarms when alterations (including addition or alteration of fuel burning appliances),
repairs, or additions requiring a permit occur, or when one or more sleeping rooms are added or created.
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18) Any changes in proposed construction shall be reviewed by the engineer or architect of record and submitted in writing to the Mason County Building
Department prior to construction. All engineering and/or architectural documents are a part of the approved set of plans and shall remain attached
thereto. If documents are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be
charged and sh a collected by the Building Department prior to any further inspections being performed or approvals granted.
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19) All construction must meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the
State of Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
permit revo v
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20) The placement of buildings and structures on or adjacent to slopes steeper than one unit vertical in three units horizontal (33.3% slopes) shall conform to
the International Residential Code Section R403.1.7 for descending or ascending slopes.
Alternate setbacks may be approved subject to approval of the building official based upon the investigation and recommendations of a qualified engineer
licensed in the State of Washington. Such an investigation shall include consideration of material, height of slope, slope gradient, load intensity, and
erosion characteristics of slope material.
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21) Proposed structure(s) must maintain a minimum of a 5' setback from all property lines, easements and 25' from all County and State Road right of ways.
Setbac cs
X m ured from the furthest projection of the structure.
22) All changes to "approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinan a re ation, must be reviewed and approved by Mason County prior to construction.
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BLD2015-01048 Please refer to the following pages for conditions of this permit. Page 4 of 6
23) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED
BUILDING CODE.
The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance
with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
Inspector shall a prior to requesting additional inspections.
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24) All property lines shall be clearly identified at the time of foundation inspection. X
25) All building permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The failure
to request a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with
Mason Con o ances and building regulations.
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26) All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may extend the time for
action for a period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
holder ha a prev ed action from being taken. No more than one extension may be granted.
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27) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connectors, and fla ng. Install metal connectors approved for contact with the new types of pressure treated material.
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28) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure
these structures meet the setback conditions listed.
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29) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
"Approved S I to ensure these structures are shown and meet the setback conditions listed.
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30) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT
PROPERTIES NOR INCRE_ASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM
OR ROAD W Y.
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BLD2015-01048 Please refer to the following pages for conditions of this permit. Page 5 of 6
OWNER/ BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by
signature below. I declare that I am the owner, owners legal representative, or contractor. I further declare that I am entitled to receive this permit and to do the
work as proposed. I have obtained permission from all the necessary parties, including any easement holder or parties of interest regarding this project. The
owner or authorized agent represents that the information provided is accurate and grants employees of Mason County access to the above described property
and structure(s)for review and inspection. This permit/application becomes null &void if work or authorized construction is not commenced within 180 days or if
construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
Signature Date
'mil( _�� (, OWNER - REPRESe to ITVE Cate) CONTRACTOR
Print Name e on
BLD2015-01048 Please refer to the following pages for conditions of this permit. Page 6 of 6
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
Permit Assistance Center
SHELTON (360) 427-9670 BELFAiR (360) 275-4467 Elma (360) 482-5269
FAX: (360) 427-7798 WEB SITE: www.co.mason.wa.us
P.O. Box 279, SHELTON 98584
2012 International Energy Conservation Code, as amended by WAC 51-11 (IECC)
Effective July 1, 2013.
Ventilation code provisions are located in the 2012 International Residential Code (IRC),
2012 International Mechanical Code (IMC), & 2012 International Building Code
A complete energy code application form will include information that clearly identifies compliance methods for
heat sizing, thermal envelope, and whole-house ventilation. This form includes compliance instructions and
information needed. Energy code compliance information, forms, worksheets, and educational information is also
available on the Washington State University Extension Energy Program (WSU-EP) website. To access the
website go to http://www.energy.wsu.edu/BuildingEfficiency/Ener.qvCode/2012EnergyCode.aspx).
The website includes a heat system sizing calculator. Submit a completed heat sizing calculator worksheet when
the building permit is submitted. In addition to the heat sizing calculator the website has helpful compliance
information and worksheets for prescriptive and component performance options along with a glazing schedule.
INSTRUCTIONS: Complete the Mason County Energy Code application and submit with a heat sizing calculator
available on the WSU-EP website, see item #4 below:
1 Identify the compliance method. The most common and simplest approach is the prescriptive method for
energy code compliance. See prescriptive table R402.1.1 located at the end of the instructions. The
component performance approach referenced in IECC Section R402.1.4 may also be used for energy
code compliance. For more information contact Mason County building department staff at (360) 427-
9670 ext. 352 or WSU Energy Program at (360) 956-2042.
2 Identify the whole-house ventilation compliance method. A ventilation system shall be installed in
accordance with The International Residential Code, Section M1507. The most common ventilation
methods include a whole-house ventilation system using exhaust fans (M1507.3.4) and a whole-house
ventilation system integrated with a forced-air system (M1507.3.5). Other ventilation systems include
whole-house ventilation system using a supply fan (M1507.3.6) and whole-house ventilation system
using a heat-recovery ventilation system (Ml507.3.7). If you need additional information we recommend
that you discuss with your heating and ventilation system professional. In addition Mason County staff
will be happy to discuss the options if you are not sure which compliance option will work for you.
3 Identify the Additional Energy Efficiency Requirements listed in Table R406.2. The drawings included
with the building permit application shall identify which options have been selected and the point value of
each option. Each one and two-family dwelling unit and townhouses are required to achieve the
following minimum number of credits:
a) Small dwelling units less than 1500 sq. feet of heated or cooled area and less than 300 sq. ft
fenestration area (skylights, doors, windows, etc), or additions to an existing building that is less
than 750 sq. ft. of heated area. — 0.5 points
b) Medium dwelling units not included in a) above {small dwelling), OR c) below {large dwelling}— 1.5
points
c) Large dwelling unit is a dwelling unit that exceeds 5000 sq. ft. of heated or cooled floor area. —2.5
points.
,. 4 Provide a completed heating/cooling system size worksheet to verify compliance to IECC R403.6. The
calculator/worksheet is available on the WSU-Energy Program website at:
http://www.energy.wsu.edu/BuildingEfficiency/EnergyCode/2012EnergyCode.aspx. Staff can also assist
with preparation of the worksheet.
5 To meet the prescriptive option all fenestration products shall comply with the required U-factor listed in
Table R402.1.4. Windows, doors, and glazed doors shall have a tested U-factor or .30 or less. When
using the small dwelling option for energy credits (a) or component performance approach provide a
fenestration schedule that identifies the square feet and U-factor of each item. Fenestration is defined in
the IECC as skylights, roof windows, vertical windows, opaque doors, glazed-doors that include products
with glass and non-glass glazing materials.
6 Identify the location and fuel type of the heating system, water heater, location of exhaust fans
(bathroom, laundry, kitchen, etc.) and R-factor of proposed insulation for walls, floors, ceilings, and
concrete slab floors on the building plans.
7 Not less than 75% of all permanently installed lamps in lighting fixtures shall be high efficacy lamps.
High efficacy lamps are defined in IECC Chapter 2 and are considered compact fluorescent lamps, T-8
or smaller diameter linear fluorescent lamps, or lamps with a minimum efficacy 40 lumens per watt for
lamps 15 watts or less, 50 lumens per watt for lamps over 15 watts to 40 watts, and 60 lumens per watt
for lamps over 40 watts.
Questions? Call Mason County Community Development at (360) 427-9670 ext. 352. WSEC compliance
information and code text is also available on the WSU-Energy Program website at:
http://www.energy.wsu.edu/BuildingEfficiency/EnergyCode/2012EnergyCode.aspx.
Prescriptive Requirements °,' for Mason County
Climate Zone 4-C, Table R402.1.1
Fenestration
Glazing U-factor
Area% Vaulted Wall Wall Slab d on
Option of Floor Vertical Skybight Ceiling Ceiling Grade int°below grade Floor Grade
(Includes doors,
windows,etc.
4C Unlimited .30 .50 R-49 R-38 R-t k,l 10/1T/B21 int R-30 R-10
Visit the WSU Energy Program website at:
http://www.energy.wsu.edu/BuildingEfficiencV/EnergvCode/2012EnergyCode.aspx or call (360) 427-9670 ext. 352
for footnote information. Log & solid timber wall with a min. avg. thickness of 3.5" are exempt from the above
grade wall insulation requirements.
BUILDING
MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
WSEC/Ventilation Code Compliance Application
Submit with heating/cooling system size worksheet (see instructions #4)
Owner: Parcel#: Type of project:
7720nd4Z an�1Total Sq. Ft. 15 Floor: floor: Heated Basement:
of heated area:: ZQ -+qra
Heating System Type: O Electric wall heater O Electric Central Furnace O LPG Furnace
VILHeat Pump with electric furnace O Heat pump with gas furnace O Ductless Heat Pump
O Boiler, specify fuel type: O Other: Specify:
A Prescriptive Option Table R402.1.1
Compliance Method O Component Performance, R402.1.3 — Calculation worksheets required
Check one::
O Other (Specify):
Check one O Whole House Ventilation system X Whole House Ventilation O Other,
Ventilation using exhaust fans&window or Integrated with a Forced Air describe:
System wall fresh air vents (M1507.3.4) System (M1507.3.5)
Referencing Table R406.2, "Additional Residential Energy Efficiency Requirements," all residential units
must develop credits as specified in Table 406.2. Identify and describe which option(s)will be used to
comply. If the table is not attached to this form you can access the table on our website at:
http://www.co.mason.wa.us/forms/Community Dev/index.php.
Additional
Energy a) Description: Small dwelling units with less than 1500 sq. feet of heated or cooled
Efficiency space and less than 300 sq. ft fenestration (see definition below) or additions to an
Requirements existing building that is less than 750 sq. ft. of heated area. To use this option
Energy credits complete a window schedule in order to verify that the fenestration area does not
exceed 300 sq. ft. Fenestration is defined in the IECC as skylights, roof windows,
required: vertical windows, opaque doors, glazed-doors that include products with glass and
non-glass glazing materials. — 0.5 points
oedium dwelling units not includes in a) above, orb) below— 1.5 points
arge dwelling unit is a dwelling unit that exceeds 5000 sq. ft. of heated or cooled floor
area. — 2.5 points.
Describe Energy Credit Option(s):
Using Option number(s): / C1
FEN ESTRATION'SCHEDULE
USE FOR ENERGY CREDIT, a) SMALL DWELLING OPTION & COMPONENT PERFORMANCE COMPLIANCE
List all windows, doors, skylights. (If needed, attach an additional sheet)
'Fenestration is defined in IECC Chapter 2 as skylights, roof windows, vertical windows; opaque doors, glazed-doors that
include products with glass and non-glass glazing materials.
Manufacturer Location U-Factor Size Quantity Total
rough opening) Square Feet
Total Fenestration: windows, skylights and door area
BUILDING
Name Parcel# 22 �� U BLD# �-u
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 2 of 2)
Based Upon the information you have provided a Stormwater Site Plan IS Required for this development activity.
Title 14, Chapter 14.48 of the Mason County Code(MCC)regulates compliance requirements for Stormwater
Management in this jurisdiction. A complete copy of the ordinance can be found on the Mason County website:
httr)//www.co.mason.wa—us/code/commissioners/index.htn
Please follow the links to "Title 14, Chapter 14.48 Stormwater Management".
Regulated activities shall be conducted only after Mason County Public Works approves a stormwater site plan
(Mason County Code Title 14 Chapter 14.48 section 14.48.70). You will receive a copy of the Public Works document
entitled"Managing Storm Drainage on Small Lots,The Small Parcel Stormwater Site Plan". This document will assist
you in preparing the necessary information and plans for Public Works to review and approve. Per Department of
Public Works this document will constitute an approved plan if all of the relevant details* are to be installed in
their entirety AND no part of the stormwater system adversely affects any septic system (see Environmental Health
information below). If an alternative system is to be used a plan will need to be submitted to Public Works for approval.
A design by a registered professional may be required for more complex sites.
*These details are found in the document Managing Scorn:Drainage on Small Lots, The Small Parcel Slormwa[er Site Plan
on the pages that begin with"Handout"
PLEASE INITIAL BELOW TO INDICATE THE STORMwATER MANAGEMENT PLAN FOR THIS SITE
A) The relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed
in their entirety AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel.
B) An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the
system will be located as not to adversely affect any septic systems on this,or any other,parcel.
If you have further questions pertaining to parcel drainage and stormwater management Mason County's Public Works
Department can provide additional instructions, guidance and examples. (Section 14.48.130)contact Public works at:
Phone: (360)-427-9670 EXT. 450
Mail: P 0 Box 1850, Shelton WA 98584
Physical: 415 N 6th St, Shelton WA 98584
If this development has,or will have,a septic/d rain field system you may need to contact Mason County Division of
Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this,or
any other,parcel.You may also wish to consult with the septic design professional involved with the project. Mason
County Division of Environmental Health can be reached at:
Phone: (360)-427-9670 EXT. 352
Mail: P 0 Box 1666, Shelton WA 98584
Physical: 426 W Cedar St, Shelton WA 98584
A condition will be added to the building permit that states,in part,that all conditions the stormwater site plan will be met
prior to a request for final inspection of the building permit.
Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
described pro rty or review and inspection as may be required.
X Owner/Agen ontractor le one)Date: e"
Page 2 of 2
Name 1:-AM 0411,_1 Parcel# J ZZl'+--S'S -0CXC4Z BLD#
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 1 of 2)
Per Mason County Code,Title 14,Chapter 14.48 a stormwater site plan is required whenever a building application is
made for residential development, or redevelopment', with more than 2,000 square feet of impervious surface2.
'Redevelopment means,on an already developed site,the creation or addition of impervious surfaces,structural development
including construction, installation or expansion of a building or other structure,and/or replacement of impervious surface that is not
part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment.
2Common impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas,
concrete or asphalt paving,gravel roads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the
natural infiltration of stormwater.Open,uncovered retention/detention facilities shall not be considered as impervious surfaces.
To Calculate Impervious Surfaces Please Complete This Table
Surface Type Length X Width = Area *All dimensions in feet
Buildings } X 40
X = Measurements for buildings are taken at the
perimeter of the farthest projections(example:
X = eaves/gutters)
X =
Driveways X Z = ?4 0
X = Length of drive begins at the right of way
X =
Parking Areas X =
X = Any paved, gravel or packed area per definition
above table
X =
Patios/Walks 09- X ZO =
X = Any paved, gravel or packed area per definition
above table
X =
Others X =
X = If the total impervious area of the proposed site
X = development is greater than 2000 square feet a
Small Parcel Stormwater Site Plan is Required
Total Impervious Surface Area(sum of all areas)
If the Total Impervious Surface Area is LESS THAN 2000 Square Feet, please read, acknowledge and sign below.
Based Upon the information you have provided a Stormwater Site Plan IS NOT required for this development activity.
Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
described property for review and inspection as may be required.
X Owner/Agent/Contractor(circle one)Date:
If the Total Impervious Surface Area is GREATER THAN 2000 Square Feet, please read, acknowledge and sign
the information provided on page 2 of 2.
Page 1 of 2
0 cop `` p
MASON COUNTY Permit No: Lpa� '0I O
. DEPARTMENT OF COMMUNITY DEVELOPMENT
BUILDING• PLANNING•FIRE MARSHAL (360)427-9670 Shelton ext. 352
_- http://www.co.mason.wa.us/community dev/ (360)275-4467 Belfair ext. 352
11454 426 W Cedar Street, Shelton WA 98584 (360)482-5269 Elma ext. 352
BING
BUILDING PERMIT APPLICATION RECEIVI
UCLPROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: 2015
NAME: EICK +-KgCZJt4 --Z, Clf�4 4 NAME:V14+� �1A4C f6o��IE.S L�426 W. CEDAR
MAILING ADDRESS:&10 iE_ MAILINGADDRESS: 2A E. YMIr-k-utw 0<
CITY: STATE: ZIP:9-j!:14 CITY:AL4-yr�1 STATE: Wja, . zmei2jr?
PHONE:, CELL: &10-ZG$-Aft PHONE:32C2,*,dQ l - qiz CELL: -ya,&,%.tg
EMAIL: : 2ACK1---.%H10L 044 QAP-talc om Gi' % EMAIL :\Jg§fsL, tDt]K HOOACS u-r-e-e tAAAk+L.C-
L&I REG# VAo-117 t D ft�)a Q l EXP.
CONTACT : OWNER❑ CONTRACTOR J� BELOW ❑
NAME: V-t4 tT-lJr4nL, D)4 MAILING ADDRESS:-,ko K4,pu KL nownLyt jrAj i)
CITY:_ LL)(NA STATE: !!�-- ZIP:q_jr!Z;4_PHONE:'3«}lot-49it CELL: Srgv��
EMAIL:Vsk-10 UlCI40M GSLAX-92 C-iryU4 t COA4
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER) IZZ- +77,��-0004Z FIRE DISTRICT
LEGAL DESCRIPTION(ABBREVIATED) : et I-u r O C✓C-c.a 000 - 0
SITE ADDRESS C10 IE. Hf.)F=g (KC f zo CTTY -A�I
DIRECTIONS TO SITE ADDRESS [ �1d Ul LtJ 4C�L_
IS PROPERTY WITHIN 200 FT:
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND ❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES❑ NO
TYPE OF JOB: NEW) ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(RESIDENCE,GARAGE ETC.) I�ZS1 D n-.LC.1f
IS USE: PRIMARY& SEASONAL❑ NUMBER OF BEDROOMS_ NUMBER OF BATHROOMS _
DESCRIBE WORKi J Ctlr�T�_[.1r.7701J
SOUARE FOOTAGE:
1ST FLOOR �sq.ft. 2ND FLOOR � ,sq.ft. 3RD FLOOR — sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER r-- sq.ft.
GARAGEC
Leff sq.ft. ATTACHED ®. DETACHED ❑ CARPORT sq.ft. ATTACHED ❑ DETACHED❑
OF RED HOME INFO N: *4 COPIES O OOR PLAN RE UIRED
MODEL YEAR L
TH ED S BATHS SERIAL NUMBE
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner or owner's legal representative. I further
declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the
necessary parties, including any easement holder or parties of interest regarding this project. The owner or legal
representative, represents that the information provided is accurate and grants employees of Mason County access to
the above described property and structure(s)for review and inspection. This permit/application becomes null &void if
work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of
180 days.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT
APPLICATION OF 180 DAYS WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON COUNTY CODE 14.08.42)
x V �s
gn a of OWNER---' Date
DEPARTMENTAL REVIEW APPROVE DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FTRE MARSHAL
.IsE' ) �' b ► k, 10N;
BUILDING PERMIT FEE FIRE ACCESS AND GRADE
PLAN REVIEW GEO-TECH REVIEW
PLUMBING&BASE FEE STORMWATER REVIEW
MECHANICAL&BASE FEE TOTAL FEES
WOOD/GAS/PELLET STOVE VIOLATION INVESTIGATION FEE
PLANNING REVIEW FEE VIOLATION FEE
+•�?'?-. - ,�:: ti.pi ." � .Z '",e _. ,''. 1 �.n'{ 'Y.�;�'i�)}, y�£FP`y'fu sF��i}'/y_ ., =sf '.,;}n� 1 :'4
CD MASON COUNTY PERMIT NO. R02C% � .-C,0C F
C%
DEPARTMENT OF COMMUNITY DEVELOPMENT
BUILDING•PLANNING•FIRE MARSHAL
_ WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352
Mason County Bldg. 111,426 West Cedar Street (360)275-4467 Belfair ext.352
1854 -- Shelton,WA 98584 (360)482-5269 Elma ext.352RE CEIVED
B U I LD I N QUMBING & MECHANICAL PERMIT APPLICATION DEC 16 2015
OWNER INFORMATION: CONTRACTOR INFORMATION: 426 W. CEDAR ST.
NAME: (l iU4 4-Ke6riCt%l- bAd NAME:U•4.-.L i)QK t:k)-o—A .S (_t_L
MAILING ADDRESS: '�SD E_ttitu�ntr>g ulCc.l tAC MAILING ADDRESS:3 Wtuv
CITY: AtLL ,I STATE: W,..- ZIP:ftST74 CITY: .4k" STATE:_Iwoo,ZIP: ' tIJSTZ4
PHONE: 3r�-7�g'- �,CELL: PHONE:?r o twx.-491 Z CELL:X4o-J!gpt-Jn t 2
EMAIL:121 L ��-1t tiu4t L.Ct�wt EMAIL :�1br.t(A' t k Egg vu�4 it
L&I REG# y0#s0x4 eir t a EXP. Itl /lX/�
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER):
LEGAL DESCRIPTION(ABBREviATED): �L_OI�CD LAt4D
SITE ADDRESS: 4tC:)`:_Hor d gt� CITY: Il�-LL>e 1�
DIRECTIONS TO SITE ADDRESS: %itl..t,..t �
TYPE OF JOB
NEW_,Y_ADD ALT REPAIR OTHER USE OF BUILDING
LOCA IT ON OF FD TURES/UNITS—11T FLOORS 2NDFLOORX_BASEMENT GARAGE OTHER
PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UNIT S
Type of Fixture No. of Fixtures Fees Fuel Type:Electric �/LPG Natural Gas Ductless_
Toilets Type of Unit No. of Units Fees
Bathroom Sink Furnace ig
Bath Tubs 3 Heat Pump
Showers 3 Spot Vent Fan
Water Heater I Propane Tank r!S
Clothes Washer 1 Gas Outlets
Kitchen Sinks 1 Wood/Gas/Pellet Stove.
Dishwasher ( Kitchen Exhaust Hood
Hose bibs Dryer Vent
Other Solar Panel
Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OWNER/BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner, owners legal representative,or contractor. I further declare
that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary parties, including
any easement holder or parties of interest regarding this project.The owner or authorized agent represents that the information provided is
accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection.This
permit/application becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is
suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. /
X A"
�—i
ignature of Applicant Dam--
X Owner/Owners Representativ Contractor
Print Name (indicate which one)
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL